Predictive Role of Lymph Node Germinal Centers in Postoperative Recurrence of Non-Small Cell Lung Cancer Treated With Immune Checkpoint Inhibitor Therapy

Introduction The germinal center (GC) in lymph nodes plays an important role in immune responses; however, their relevance to the effects of immune checkpoint inhibitor (ICI) remains unclear. The relationship between GC and ICI efficacy is investigated in this study. Materials and methods This investigation included 16 non-small cell lung cancer (NSCLC) patients with postoperative recurrence who were treated with immune checkpoint inhibitors (ICI) between January 2016 and April 2022. Patients were categorized into two groups based on the presence of GC in the lymph nodes. Additionally, the association between the number of lymph nodes dissected during pulmonary resection and ICI efficacy was evaluated. Results Sixteen patients were included with eight GC+ patients and eight GC- patients. The presence of GC positively influenced ICI efficacy, with the objective response rate (ORR) being significantly higher in the GC+ group (62.5%) compared to the GC- group (12.5%) (p=0.039). Disease control rate (DCR) was also more favorable in the GC+ group (100%) compared to the GC- group (50%) (p=0.021). Additionally, patients with fewer lymph nodes dissected at surgery had a better progression-free survival (median: 15.7 months) than those with more lymph nodes dissected (median: 7.4 months) (p=0.027). Conclusion GC in the lymph nodes can enhance the efficacy of ICI in treating NSCLC. Moreover, the number of dissected lymph nodes has emerged as a crucial prognostic factor that influences the effectiveness of treatment. These findings underscore the importance of considering lymph node characteristics in personalized ICI therapy for NSCLC.